Hospital Anxiety and Depression Scale (HADS) - Stroke Engine

The HADS is a self-administered measure with 14 items in total that ask the client to reflect on their mood in the past week. Seven items assess depression ... Skiptocontent HospitalAnxietyandDepressionScale(HADS) BacktoTop Close HospitalAnxietyandDepressionScale(HADS) EvidenceReviewedasofbefore:19-08-2008 Author(s)*:LisaZeltzer,MScOT;LorieKloda,PhD Editor(s):NicolKorner-Bitensky,PhDOT;ElissaSitcoff,BABSc Purpose TheHospitalAnxietyandDepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.Scale(HADS)isaself-administeredmeasureusedtoscreenforthepresenceofdepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.andanxiety.TheHADSwasdevelopedtoprovideclinicianswithanacceptable,reliable,validandeasytousepracticaltoolforidentifyingandquantifyingdepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.andanxiety.TheHADScanbeusedinavarietyofsettings(e.g.community,primarycare,in-hospital,andpsychiatry).TheHADSisnotintendedasacompletediagnostictool,butasameansforidentifyinggeneralhospitalpatientswhoneedfurtherpsychiatricevaluationandassistance(Herrmann,1997). In-DepthReview Purposeofthemeasure TheHospitalAnxietyandDepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.Scale(HADS)isaself-administeredmeasureusedtoscreenforthepresenceofdepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.andanxiety.TheHADSwasdevelopedtoprovideclinicianswithanacceptable,reliable,validandeasytousepracticaltoolforidentifyingandquantifyingdepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.andanxiety.TheHADScanbeusedinavarietyofsettings(e.g.community,primarycare,in-hospital,andpsychiatry).TheHADSisnotintendedasacompletediagnostictool,butasameansforidentifyinggeneralhospitalpatientswhoneedfurtherpsychiatricevaluationandassistance(Herrmann,1997). Availableversions TheHADSwasdevelopedbyDr.PhillipSnaithandAnthonyZigmondin1983. Featuresofthemeasure Items: TheHADSisaself-administeredmeasurewith14itemsintotalthatasktheclienttoreflectontheirmoodinthepastweek.SevenitemsassessdepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.,5ofwhicharemarkersforanhedonia(aninabilitytoexperiencepleasure),and2concernappearanceandfeelingsofslowingdown.Sevenitemsassessanxiety,ofwhich2assessautonomicanxiety(panicandbutterfliesinthestomach),andtheremaining5assesstensionandrestlessness(Dunbar,Ford,Hunt,&Der,2000).TheHADScanbeadministeredrepeatedlywithoutimpactingonvalidityThedegreetowhichanassessmentmeasureswhatitissupposedtomeasure.,butatleastoneweekshouldelapsebetweenadministrations. Scoring: ScoresforitemsineachsubscaleManymeasurementinstrumentsaremultidimensionalandaredesignedtomeasuremorethanoneconstructormorethanonedomainofasingleconstruct.Insuchinstancessubscalescanbeconstructedinwhichthevariousitemsfromascalearegroupedintosubscales.Althoughasubscalecouldconsistofasingleitem,inmostcasessubscalesconsistofmultipleindividualitemsthathavebeencombinedintoacompositescore(NationalMultipleSclerosisSociety).oftheHADSaresummedtoproduceananxietyscore(HADS-A)oradepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.score(HADS-D),orcanbeaddedtoproduceatotalscore(HADS-T).Eachitemisratedona4-pointscale(rangingfrom0=nonotatall,to3=yesdefinitely),foratotalscorerangingfrom0-21foreachsubscaleManymeasurementinstrumentsaremultidimensionalandaredesignedtomeasuremorethanoneconstructormorethanonedomainofasingleconstruct.Insuchinstancessubscalescanbeconstructedinwhichthevariousitemsfromascalearegroupedintosubscales.Althoughasubscalecouldconsistofasingleitem,inmostcasessubscalesconsistofmultipleindividualitemsthathavebeencombinedintoacompositescore(NationalMultipleSclerosisSociety)..Ahigherscoreindicateshigherdistress.Anumberofitemsarereversescored(rangingfrom3=nonotatall,to0=yesdefinitely),includingtwofromtheHADS-AandfourfromtheHADS-D. Intheoriginalpublication,ascoreof0to7foreithersubscaleManymeasurementinstrumentsaremultidimensionalandaredesignedtomeasuremorethanoneconstructormorethanonedomainofasingleconstruct.Insuchinstancessubscalescanbeconstructedinwhichthevariousitemsfromascalearegroupedintosubscales.Althoughasubscalecouldconsistofasingleitem,inmostcasessubscalesconsistofmultipleindividualitemsthathavebeencombinedintoacompositescore(NationalMultipleSclerosisSociety).wasregardedasinthenormalrange,ascoreof11orhigherindicatingprobablepresence(‘caseness’)ofamooddisorder,andascoreof8to10beingsuggestiveofthepresenceofthestate(Zigmond&Snaith,1983).ArecentpublicationinindividualswithstrokeAlsocalleda“brainattack”andhappenswhenbraincellsdiebecauseofinadequatebloodflow.20%ofcasesareahemorrhageinthebraincausedbyaruptureorleakagefromabloodvessel.80%ofcasesarealsoknowasa“schemicstroke”,ortheformationofabloodclotinavesselsupplyingbloodtothebrain.MoredeterminedthatanoptimalbalanceisachievedbetweenspecificitySpecificityreferstotheprobabilitythatadiagnostictechniquewillindicateanegativetestresultwhentheconditionisabsent(truenegative).usingacut-offscoreof11forthetotalHADS,and8fortheHADS-D(Aben,Verhey,Lousberg,Lodder,&Honig,2002). Time: TheHADSisabriefmeasure,andcanbecompletedquicklywhilewaitingtobeseenbyaclinician.Administrationtimerangesfrom2-5minutes.AnexperiencedcliniciancanscoretheHADSin1minute(Herrmann,1997). Subscales: TheHADShastwosubscales,theHADS-A(AnxietysubscaleManymeasurementinstrumentsaremultidimensionalandaredesignedtomeasuremorethanoneconstructormorethanonedomainofasingleconstruct.Insuchinstancessubscalescanbeconstructedinwhichthevariousitemsfromascalearegroupedintosubscales.Althoughasubscalecouldconsistofasingleitem,inmostcasessubscalesconsistofmultipleindividualitemsthathavebeencombinedintoacompositescore(NationalMultipleSclerosisSociety).)andtheHADS-D(DepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.subscaleManymeasurementinstrumentsaremultidimensionalandaredesignedtomeasuremorethanoneconstructormorethanonedomainofasingleconstruct.Insuchinstancessubscalescanbeconstructedinwhichthevariousitemsfromascalearegroupedintosubscales.Althoughasubscalecouldconsistofasingleitem,inmostcasessubscalesconsistofmultipleindividualitemsthathavebeencombinedintoacompositescore(NationalMultipleSclerosisSociety).). Equipment: OnlythequestionnaireandapencilarerequiredtocompletetheHADS. Training: NoformaltrainingisrequiredfortheHADS. AlternativeformsoftheHospitalAnxietyandDepressionScale TheHADScanbeintervieweradministeredinpersonoroverthetelephoneforclientswhomayhavedifficultywithself-administration.However,resultsfromarecentstudyoftheHADSinpersonsinthegeneralpopulationaged13-23demonstratedthatindividualsaged16-23tendedtohavehigherscoreswheninterviewedoverthetelephonethanwhenself-completedbypost,andthiswasmorepronouncedinfemales(Jörngården,Wettergen,vonEssen,2006). Clientsuitability Canbeusedwith: TheHADScanbeadministeredtoclientswithstrokeAlsocalleda“brainattack”andhappenswhenbraincellsdiebecauseofinadequatebloodflow.20%ofcasesareahemorrhageinthebraincausedbyaruptureorleakagefromabloodvessel.80%ofcasesarealsoknowasa“schemicstroke”,ortheformationofabloodclotinavesselsupplyingbloodtothebrain.More. However,forclientswithcommunicationproblems,anaphasiaAphasiaisanacquireddisordercausedbyaninjurytothebrainandaffectsaperson’sabilitytocommunicate.Itismostoftentheresultofstrokeorheadinjury.Anindividualwithaphasiamayexperiencedifficultyexpressingthemselveswhenspeaking,difficultyunderstandingthespeechofothers,anddifficultyreadingandwriting.Sadly,aphasiacanmaskaperson’sintelligenceandabilitytocommunicatefeelings,thoughtsandemotions.(TheAphasiaInstitute,Canada)specificassessmentsuchastheStrokeAlsocalleda“brainattack”andhappenswhenbraincellsdiebecauseofinadequatebloodflow.20%ofcasesareahemorrhageinthebraincausedbyaruptureorleakagefromabloodvessel.80%ofcasesarealsoknowasa“schemicstroke”,ortheformationofabloodclotinavesselsupplyingbloodtothebrain.MoreAphasicDepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.Questionnaire(Sutcliffe&Lincoln,1998)isrecommended. TheHADShasalsobeenvalidatedforusewithadolescents(White,Leach,Sims,Atkinson,&Cottrell,1999);somaticandpsychiatriccases;primarycarepatients(Olsson,Mykletun,&Dahl,2005);andthegeneralpopulation. Shouldnotbeusedin: CompletionoftheHADSrequiresthattheclienthaveadequatereadingcomprehensionandvisualability,asitisaself-administeredmeasure.However,inthecaseofilliteracyorpoorvision,theitemsandpossibleresponsesmaybereadtotherespondent(Snaith,2003).Note:althoughanumberofstudiesdouseinterviewer-administrationoftheHADS,toourknowledgenostudieshaveexaminedthevalidityThedegreetowhichanassessmentmeasureswhatitissupposedtomeasure.ofthisformofadministrationinclientswithstrokeAlsocalleda“brainattack”andhappenswhenbraincellsdiebecauseofinadequatebloodflow.20%ofcasesareahemorrhageinthebraincausedbyaruptureorleakagefromabloodvessel.80%ofcasesarealsoknowasa“schemicstroke”,ortheformationofabloodclotinavesselsupplyingbloodtothebrain.More. Iftheclient’sliteracyisinquestion,itisadvisedthatpriortoallowingtheclienttoself-administertheHADS,theclinicianasktherespondenttoreadoutaphrasefromthequestionnaireasameansofscreeningTestingfordiseaseinpeoplewithoutsymptoms.forilliteracy,assomeindividualsmaypretendtoreadthestatementsandhaphazardlyunderlineresponses(Snaith,2003). Inwhatlanguagesisthemeasureavailable? TheHADShasbeentranslatedbytheMAPIResearchInstituteintothefollowinglanguages: Afrikaans Finnish Lithuanian Swedish Arabic French Malay Tagalog Bengali German* Malayalam Tamil Brazilian Greek Marathi Telugu Bulgarian Gujurati Norwegian Thai Chinese–Cantonese Hungarian Polish Turkish Chinese–Mandarin Icelandic Portugal Urdu Croatian Indonesian Punjabi Ukrainian Czech Italian Romanian Xhosa Danish Japanese Russian Yoruba Dutch Kannada Slovak Estonian Korean Slovenian Farsi Latvian Spanish *ThecopyrightfortheGermantranslationsisheldbyVerlagHansHuber,Bern,Switzerland.Pleaseconsulthttp://www.testzentrale.de/ TheHADShasbeentranslatedandvalidatedin: Greek(Michopoulos,Douzenis,Kalkavoura,Christodoulou,Michalopoulou,Kalemietal.,2008) Hungarian(Muszbek,Szekely,Balogh,Molnar,Rohanszky,etal.,2006) Iranian(Montazeri,Vahdaninia,Ebrahimi,&Jarvandi,2003) PunjabilivinginUnitedKingdom(Lane,Jajoo,Taylor,Lip,Jolly,&BRUMSteeringCommittee,2007) Summary Whatdoesthetoolmeasure? DepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.andanxiety. Whattypesofclientscanthetoolbeusedfor? Generalhospitalpatients.Canbeused,butisnotlimitedto,personswithstrokeAlsocalleda“brainattack”andhappenswhenbraincellsdiebecauseofinadequatebloodflow.20%ofcasesareahemorrhageinthebraincausedbyaruptureorleakagefromabloodvessel.80%ofcasesarealsoknowasa“schemicstroke”,ortheformationofabloodclotinavesselsupplyingbloodtothebrain.More. IsthisascreeningTestingfordiseaseinpeoplewithoutsymptoms.orassessmenttool? ScreeningTestingfordiseaseinpeoplewithoutsymptoms.. Timetoadminister TheHADSisabriefmeasure,andcanbecompletedquicklywhilewaitingtobeseenbyaclinician.Administrationtimerangesfrom2-5minutes.AnexperiencedcliniciancanscoretheHADSin1minute(Herrmann,1997). Versions TheHADSwasdevelopedbyDr.PhillipSnaithandAnthonyZigmondin1983.Itisintendedtobeself-administeredbutcanbeinterviewadministeredinpersonoroverthetelephoneforclientswhomayhavedifficultyself-administeringthemeasure. OtherLanguages Translatedandvalidatedin:Greek;Hungarian;Iranian;PunjabilivinginUnitedKingdom TheHADShasbeentranslatedbutnotnecessarilyvalidatedin51languages(seeHADSmoduleforthefulllistoftranslations). MeasurementProperties ReliabilityReliabilitycanbedefinedinavarietyofways.Itisgenerallyunderstoodtobetheextenttowhichameasureisstableorconsistentandproducessimilarresultswhenadministeredrepeatedly.Amoretechnicaldefinitionofreliabilityisthatitistheproportionof“true”variationinscoresderivedfromaparticularmeasure.Thetotalvariationinanygivenscoremaybethoughtofasconsistingoftruevariation(thevariationofinterest)anderrorvariation(whichincludesrandomerroraswellassystematicerror).Truevariationisthatvariationwhichactuallyreflectsdifferencesintheconstructunderstudy,e.g.,theactualseverityofneurologicalimpairment.Randomerrorrefersto“noise”inthescoresduetochancefactors,e.g.,aloudnoisedistractsapatientthusaffectinghisperformance,which,inturn,affectsthescore.Systematicerrorreferstobiasthatinfluencesscoresinaspecificdirectioninafairlyconsistentway,e.g.,oneneurologistinagrouptendstorateallpatientsasbeingmoredisabledthandootherneurologistsinthegroup.Therearemanyvariationsonthemeasurementofreliabilityincludingalternate-forms,internalconsistency,inter-rateragreement,intra-rateragreement,andtest-retest. InternalconsistencyAmethodofmeasuringreliability.Internalconsistencyreflectstheextenttowhichitemsofatestmeasurevariousaspectsofthesamecharacteristicandnothingelse.Internalconsistencycoefficientscantakeonvaluesfrom0to1.Highervaluesrepresenthigherlevelsofinternalconsistency.More: OutoftwostudiesexamininginternalconsistencyAmethodofmeasuringreliability.Internalconsistencyreflectstheextenttowhichitemsofatestmeasurevariousaspectsofthesamecharacteristicandnothingelse.Internalconsistencycoefficientscantakeonvaluesfrom0to1.Highervaluesrepresenthigherlevelsofinternalconsistency.MoreoftheHADSinastrokeAlsocalleda“brainattack”andhappenswhenbraincellsdiebecauseofinadequatebloodflow.20%ofcasesareahemorrhageinthebraincausedbyaruptureorleakagefromabloodvessel.80%ofcasesarealsoknowasa“schemicstroke”,ortheformationofabloodclotinavesselsupplyingbloodtothebrain.Moreclientele,onereportedexcellentandoneadequatetoexcellentinternalconsistencyAmethodofmeasuringreliability.Internalconsistencyreflectstheextenttowhichitemsofatestmeasurevariousaspectsofthesamecharacteristicandnothingelse.Internalconsistencycoefficientscantakeonvaluesfrom0to1.Highervaluesrepresenthigherlevelsofinternalconsistency.More. Test-retest: Nostudieshaveexaminedthetest-retestreliabilityAwayofestimatingthereliabilityofascaleinwhichindividualsareadministeredthesamescaleontwodifferentoccasionsandthenthetwoscoresareassessedforconsistency.Thismethodofevaluatingreliabilityisappropriateonlyifthephenomenonthatthescalemeasuresisknowntobestableovertheintervalbetweenassessments.Ifthephenomenonbeingmeasuredfluctuatessubstantiallyovertime,thenthetest-retestparadigmmaysignificantlyunderestimatereliability.Inusingtest-retestreliability,theinvestigatorneedstotakeintoaccountthepossibilityofpracticeeffects,whichcanartificiallyinflatetheestimateofreliability(NationalMultipleSclerosisSociety).oftheHADSinclientswithstrokeAlsocalleda“brainattack”andhappenswhenbraincellsdiebecauseofinadequatebloodflow.20%ofcasesareahemorrhageinthebraincausedbyaruptureorleakagefromabloodvessel.80%ofcasesarealsoknowasa“schemicstroke”,ortheformationofabloodclotinavesselsupplyingbloodtothebrain.More. ValidityThedegreetowhichanassessmentmeasureswhatitissupposedtomeasure. Criterion: Concurrent: TheconcurrentvalidityTovalidateanewmeasure,theresultsofthemeasurearecomparedtotheresultsofthegoldstandardobtainedatapproximatelythesamepointintime(concurrently),sotheybothreflectthesameconstruct.Thisapproachisusefulinsituationswhenaneworuntestedtoolispotentiallymoreefficient,easiertoadminister,morepractical,orsaferthananothermoreestablishedmethodandisbeingproposedasanalternativeinstrument.Seealso“goldstandard.”oftheHADShasnotbeenexaminedinastrokeAlsocalleda“brainattack”andhappenswhenbraincellsdiebecauseofinadequatebloodflow.20%ofcasesareahemorrhageinthebraincausedbyaruptureorleakagefromabloodvessel.80%ofcasesarealsoknowasa“schemicstroke”,ortheformationofabloodclotinavesselsupplyingbloodtothebrain.Morepopulation.StudiesthathaveexaminedtheconcurrentvalidityTovalidateanewmeasure,theresultsofthemeasurearecomparedtotheresultsofthegoldstandardobtainedatapproximatelythesamepointintime(concurrently),sotheybothreflectthesameconstruct.Thisapproachisusefulinsituationswhenaneworuntestedtoolispotentiallymoreefficient,easiertoadminister,morepractical,orsaferthananothermoreestablishedmethodandisbeingproposedasanalternativeinstrument.Seealso“goldstandard.”oftheHADSinotherpopulationsreportexcellentcorrelationsbetweentheHADSandBeckDepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.Inventory,theGeneralHealthQuestionnaire,theClinicalAnxietyScale,theSpielberger’sState-TraitAnxietyInventory,andtheMontgomeryAsbergDepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.RatingScale.AdequatetoexcellentcorrelationsfoundbetweentheHADSandtheSymptomChecklist-90Scale.AdequatecorrelationsbetweentheHADS-AandtheHamiltonAnxietyRatingScale. Construct: Onereviewarticleof18studiesfoundexcellentmeancorrelationTheextenttowhichtwoormorevariablesareassociatedwithoneanother.Acorrelationcanbepositive(asonevariableincreases,theotheralsoincreases–forexampleheightandweighttypicallyrepresentapositivecorrelation)ornegative(asonevariableincreases,theotherdecreases–forexampleasthecostofgasolinegoeshigher,thenumberofmilesdrivendecreases.Thereareawidevarietyofmethodsformeasuringcorrelationincluding:intraclasscorrelationcoefficients(ICC),thePearsonproduct-momentcorrelationcoefficient,andtheSpearmanrank-ordercorrelation.betweentheHADS-AandHADS-D.Inanotherreview,sevenstudiesfoundadequatetoexcellentcorrelationsbetweenHADS-AandHADS-Dinnon-patientsamples,andtwostudiesreportedadequatecorrelationsinpsychiatricpatients. Doesthetooldetectchangeinpatients? Inastudyof200clientswithstrokeAlsocalleda“brainattack”andhappenswhenbraincellsdiebecauseofinadequatebloodflow.20%ofcasesareahemorrhageinthebraincausedbyaruptureorleakagefromabloodvessel.80%ofcasesarealsoknowasa“schemicstroke”,ortheformationofabloodclotinavesselsupplyingbloodtothebrain.More,themeancorrelationTheextenttowhichtwoormorevariablesareassociatedwithoneanother.Acorrelationcanbepositive(asonevariableincreases,theotheralsoincreases–forexampleheightandweighttypicallyrepresentapositivecorrelation)ornegative(asonevariableincreases,theotherdecreases–forexampleasthecostofgasolinegoeshigher,thenumberofmilesdrivendecreases.Thereareawidevarietyofmethodsformeasuringcorrelationincluding:intraclasscorrelationcoefficients(ICC),thePearsonproduct-momentcorrelationcoefficient,andtheSpearmanrank-ordercorrelation.betweenthedepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.andanxietysubscalesoftheHADSwasfoundtobeexcellent. Acceptability HADSistypicallyself-administered,howeveritcanbeinterviewadministeredinpersonorbytelephoneforclientswhoareunabletoself-administerthemeasure.TheHADSisnotrecommendedforusewithclientswithcommunicationproblems. Feasibility TheHADSisashort,self-administeredscreeningTestingfordiseaseinpeoplewithoutsymptoms.tool.Ittakesonlyoneminutetoscorebyanexperiencedclinicianandnospecialequipmentisrequired. Howtoobtainthetool? TheoriginalHADSisavailableasanappendixinZigmondandSnaith(1983).Acopyofthearticleisavailablebyclickinghere.TheHADSisalsoavailablefromthefollowingwebsite:http://shop.gl-assessment.co.uk/home.php?cat=417. PsychometricProperties Overview WeconductedaliteraturesearchtoidentifyallrelevantpublicationsonthepsychometricpropertiesoftheHADSinindividualswithstrokeAlsocalleda“brainattack”andhappenswhenbraincellsdiebecauseofinadequatebloodflow.20%ofcasesareahemorrhageinthebraincausedbyaruptureorleakagefromabloodvessel.80%ofcasesarealsoknowasa“schemicstroke”,ortheformationofabloodclotinavesselsupplyingbloodtothebrain.More.AlthoughthepsychometricpropertiesoftheHADShavebeenwellestablishedinotherpatientpopulations,therearefewstudiestodatethathaveexaminedthepsychometricpropertiesoftheHADSinindividualswithstrokeAlsocalleda“brainattack”andhappenswhenbraincellsdiebecauseofinadequatebloodflow.20%ofcasesareahemorrhageinthebraincausedbyaruptureorleakagefromabloodvessel.80%ofcasesarealsoknowasa“schemicstroke”,ortheformationofabloodclotinavesselsupplyingbloodtothebrain.More. Floor/CeilingEffects AccordingtothecommentarybyHerrmann(1997)inhisreview,theHADSdoesnotincludeseverepathologicalsymptomsofthetwodisorders(anxietyanddepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.).ThiswasdonetoenhancesensitivitySensitivityreferstotheprobabilitythatadiagnostictechniquewilldetectaparticulardiseaseorconditionwhenitdoesindeedexistinapatient(NationalMultipleSclerosisSociety).Seealso“Specificity.”oftheHADStomildcases,thusavoidingthepotentialforaceilingeffectAceilingeffectoccurswhentestitemsaren’tchallengingenoughforagroupofindividuals.Thus,thetestscorewillnotincreaseforasubsampleofpeoplewhomayhaveclinicallyimprovedbecausetheyhavealreadyreachedthehighestscorethatcanbeachievedonthattest.Inotherwords,becausethetesthasalimitednumberofdifficultitems,themosthighlyfunctioningindividualswillscoreatthehighestpossiblescore.Thisbecomesameasurementproblemwhenyouaretryingtoidentifychanges–thepersonmaycontinuetoimprovebutthetestdoesnotcapturethatimprovement.Example:Amemorytestthatassesseshowmanywordsaparticipantcanrecallhasatotaloffivewordsthateachparticipantisaskedtoremember.Becausemostindividualscanrememberallfivewords,thismeasurehasaceilingeffect.Seealso“flooreffect.”Moreoftenencounteredwithpsychiatricquestionnairesusedformedicalpatients. Reliability InternalconsistencyAmethodofmeasuringreliability.Internalconsistencyreflectstheextenttowhichitemsofatestmeasurevariousaspectsofthesamecharacteristicandnothingelse.Internalconsistencycoefficientscantakeonvaluesfrom0to1.Highervaluesrepresenthigherlevelsofinternalconsistency.More: Aben,Verhey,Lousberg,Lodder,andHonig(2002)administeredtheHADSto200patientsonemonthfollowingafirsteverischemicstrokeAlsocalleda“brainattack”andhappenswhenbraincellsdiebecauseofinadequatebloodflow.20%ofcasesareahemorrhageinthebraincausedbyaruptureorleakagefromabloodvessel.80%ofcasesarealsoknowasa“schemicstroke”,ortheformationofabloodclotinavesselsupplyingbloodtothebrain.MoreandfoundtheinternalconsistencyAmethodofmeasuringreliability.Internalconsistencyreflectstheextenttowhichitemsofatestmeasurevariousaspectsofthesamecharacteristicandnothingelse.Internalconsistencycoefficientscantakeonvaluesfrom0to1.Highervaluesrepresenthigherlevelsofinternalconsistency.MoreoftheHADStobeexcellent,withaCronbach’salpha=0.85. Johnston,Pollard,andHennessey(2000)administeredtheHADSto68individualswithacutestrokeAlsocalleda“brainattack”andhappenswhenbraincellsdiebecauseofinadequatebloodflow.20%ofcasesareahemorrhageinthebraincausedbyaruptureorleakagefromabloodvessel.80%ofcasesarealsoknowasa“schemicstroke”,ortheformationofabloodclotinavesselsupplyingbloodtothebrain.Morewithin10-20daysofthestudy.At1monthpost-stroke,cronbach’salphawasadequatefortheHADS-A(alpha=0.76);HADS-D(alpha=0.79),andoverallHADS(alpha=0.79).At6monthspost-stroke,theHADS-AandoverallHADShadexcellentinternalconsistencyAmethodofmeasuringreliability.Internalconsistencyreflectstheextenttowhichitemsofatestmeasurevariousaspectsofthesamecharacteristicandnothingelse.Internalconsistencycoefficientscantakeonvaluesfrom0to1.Highervaluesrepresenthigherlevelsofinternalconsistency.More(alpha=0.87;0.89,respectively)andtheHADS-Dwasadequate(alpha=0.76). Test-retest: Todate,thetest-retestreliabilityAwayofestimatingthereliabilityofascaleinwhichindividualsareadministeredthesamescaleontwodifferentoccasionsandthenthetwoscoresareassessedforconsistency.Thismethodofevaluatingreliabilityisappropriateonlyifthephenomenonthatthescalemeasuresisknowntobestableovertheintervalbetweenassessments.Ifthephenomenonbeingmeasuredfluctuatessubstantiallyovertime,thenthetest-retestparadigmmaysignificantlyunderestimatereliability.Inusingtest-retestreliability,theinvestigatorneedstotakeintoaccountthepossibilityofpracticeeffects,whichcanartificiallyinflatetheestimateofreliability(NationalMultipleSclerosisSociety).oftheHADShasnotbeenexaminedinastrokeAlsocalleda“brainattack”andhappenswhenbraincellsdiebecauseofinadequatebloodflow.20%ofcasesareahemorrhageinthebraincausedbyaruptureorleakagefromabloodvessel.80%ofcasesarealsoknowasa“schemicstroke”,ortheformationofabloodclotinavesselsupplyingbloodtothebrain.Morepopulation. Validity Toourknowledge,thestudybyAbenetal.(2002)istheonlystudytodatethathasexaminedthevalidityThedegreetowhichanassessmentmeasureswhatitissupposedtomeasure.oftheHADSinindividualswithstrokeAlsocalleda“brainattack”andhappenswhenbraincellsdiebecauseofinadequatebloodflow.20%ofcasesareahemorrhageinthebraincausedbyaruptureorleakagefromabloodvessel.80%ofcasesarealsoknowasa“schemicstroke”,ortheformationofabloodclotinavesselsupplyingbloodtothebrain.More. Criterion: Concurrent: TheconcurrentvalidityTovalidateanewmeasure,theresultsofthemeasurearecomparedtotheresultsofthegoldstandardobtainedatapproximatelythesamepointintime(concurrently),sotheybothreflectthesameconstruct.Thisapproachisusefulinsituationswhenaneworuntestedtoolispotentiallymoreefficient,easiertoadminister,morepractical,orsaferthananothermoreestablishedmethodandisbeingproposedasanalternativeinstrument.Seealso“goldstandard.”oftheHADShasnotbeenexaminedinastrokeAlsocalleda“brainattack”andhappenswhenbraincellsdiebecauseofinadequatebloodflow.20%ofcasesareahemorrhageinthebraincausedbyaruptureorleakagefromabloodvessel.80%ofcasesarealsoknowasa“schemicstroke”,ortheformationofabloodclotinavesselsupplyingbloodtothebrain.Morepopulation.BelowwepresentthefindingsofstudiesthathaveexaminedtheconcurrentvalidityTovalidateanewmeasure,theresultsofthemeasurearecomparedtotheresultsofthegoldstandardobtainedatapproximatelythesamepointintime(concurrently),sotheybothreflectthesameconstruct.Thisapproachisusefulinsituationswhenaneworuntestedtoolispotentiallymoreefficient,easiertoadminister,morepractical,orsaferthananothermoreestablishedmethodandisbeingproposedasanalternativeinstrument.Seealso“goldstandard.”oftheHADSinotherpopulations. InareviewbyBjellandetal.(2002),concurrentvalidityTovalidateanewmeasure,theresultsofthemeasurearecomparedtotheresultsofthegoldstandardobtainedatapproximatelythesamepointintime(concurrently),sotheybothreflectthesameconstruct.Thisapproachisusefulinsituationswhenaneworuntestedtoolispotentiallymoreefficient,easiertoadminister,morepractical,orsaferthananothermoreestablishedmethodandisbeingproposedasanalternativeinstrument.Seealso“goldstandard.”oftheHADSwasexaminedagainstexistinganxietyanddepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.questionnairesandinterviewinstruments(BeckDepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.Inventory(BDI),BeckDepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.InventoryforPrimaryCare,ClinicalAnxietyScale,HamiltonAnxietyScale,Montgomery-AsbergDepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.RatingScale,SymptomChecklist90Scale,SpielbergerState-TraitAnxietyInventory,andVisualAnalogueScale).CorrelationsbetweentheHADSandtheBDIwereexcellent,rangingfromr=0.61to0.83.CorrelationsbetweentheGeneralHealthQuestionnaireandHADSrangedfromadequatetoexcellent(r=0.50to0.68).CorrelationsbetweentheHADSandtheClinicalAnxietyScalewereexcellent,rangingfromr=0.69to0.75.CorrelationsbetweentheHADSandtheSpielberger’sState-TraitAnxietyInventorywereexcellent,rangingfromr=0.64to0.81.CorrelationsbetweentheHADSandtheSymptomChecklist90Scalerangedfromadequatetoexcellent(r=0.49to0.73).CorrelationsbetweentheHADSandtheMontgomeryAsbergDepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.RatingScalewereexcellent,rangingfromr=0.62to0.81.Finally,adequatecorrelationswerefoundbetweentheHADS-AandtheHamiltonAnxietyRatingScale(r=0.34to0.44). ClarkandSteer(1994)reportedthattheHADShadanexcellentcorrelationTheextenttowhichtwoormorevariablesareassociatedwithoneanother.Acorrelationcanbepositive(asonevariableincreases,theotheralsoincreases–forexampleheightandweighttypicallyrepresentapositivecorrelation)ornegative(asonevariableincreases,theotherdecreases–forexampleasthecostofgasolinegoeshigher,thenumberofmilesdrivendecreases.Thereareawidevarietyofmethodsformeasuringcorrelationincluding:intraclasscorrelationcoefficients(ICC),thePearsonproduct-momentcorrelationcoefficient,andtheSpearmanrank-ordercorrelation.(PearsoncorrelationTheextenttowhichtwoormorevariablesareassociatedwithoneanother.Acorrelationcanbepositive(asonevariableincreases,theotheralsoincreases–forexampleheightandweighttypicallyrepresentapositivecorrelation)ornegative(asonevariableincreases,theotherdecreases–forexampleasthecostofgasolinegoeshigher,thenumberofmilesdrivendecreases.Thereareawidevarietyofmethodsformeasuringcorrelationincluding:intraclasscorrelationcoefficients(ICC),thePearsonproduct-momentcorrelationcoefficient,andtheSpearmanrank-ordercorrelation.r=0.73)withthe13-itemCognitive-AffectiveSubscaleManymeasurementinstrumentsaremultidimensionalandaredesignedtomeasuremorethanoneconstructormorethanonedomainofasingleconstruct.Insuchinstancessubscalescanbeconstructedinwhichthevariousitemsfromascalearegroupedintosubscales.Althoughasubscalecouldconsistofasingleitem,inmostcasessubscalesconsistofmultipleindividualitemsthathavebeencombinedintoacompositescore(NationalMultipleSclerosisSociety).oftheBeckDepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.Inventoryinastudytodiscriminatebetweendepressedandnon-depressedhospitalizedpatients. Construct: Convergent/Discriminant: Abenetal.(2002)foundthemeancorrelationTheextenttowhichtwoormorevariablesareassociatedwithoneanother.Acorrelationcanbepositive(asonevariableincreases,theotheralsoincreases–forexampleheightandweighttypicallyrepresentapositivecorrelation)ornegative(asonevariableincreases,theotherdecreases–forexampleasthecostofgasolinegoeshigher,thenumberofmilesdrivendecreases.Thereareawidevarietyofmethodsformeasuringcorrelationincluding:intraclasscorrelationcoefficients(ICC),thePearsonproduct-momentcorrelationcoefficient,andtheSpearmanrank-ordercorrelation.betweenthedepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.andanxietysubscalesoftheHADStobeexcellent(r=0.67).Herrmann(1997)assertsthatthecorrelationTheextenttowhichtwoormorevariablesareassociatedwithoneanother.Acorrelationcanbepositive(asonevariableincreases,theotheralsoincreases–forexampleheightandweighttypicallyrepresentapositivecorrelation)ornegative(asonevariableincreases,theotherdecreases–forexampleasthecostofgasolinegoeshigher,thenumberofmilesdrivendecreases.Thereareawidevarietyofmethodsformeasuringcorrelationincluding:intraclasscorrelationcoefficients(ICC),thePearsonproduct-momentcorrelationcoefficient,andtheSpearmanrank-ordercorrelation.betweenthetwosubscalesisaresultoftheexistingoverlapbetweenthesymptomsofdepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.andanxietyandnotareflectionofaflawintheinstrument. SensitivitySensitivityreferstotheprobabilitythatadiagnostictechniquewilldetectaparticulardiseaseorconditionwhenitdoesindeedexistinapatient(NationalMultipleSclerosisSociety).Seealso“Specificity.”andSpecificitySpecificityreferstotheprobabilitythatadiagnostictechniquewillindicateanegativetestresultwhentheconditionisabsent(truenegative).: O’Rourke,MacHale,Signorini,andDennis(1998)administeredtheHADSto105individualswithstrokeAlsocalleda“brainattack”andhappenswhenbraincellsdiebecauseofinadequatebloodflow.20%ofcasesareahemorrhageinthebraincausedbyaruptureorleakagefromabloodvessel.80%ofcasesarealsoknowasa“schemicstroke”,ortheformationofabloodclotinavesselsupplyingbloodtothebrain.More6monthsafteronset.TheyfoundthetypicalcutoffsfortheHADStobesuboptimalwhencomparedtotheresultsofablindedpsychiatricassessmentinwhichtheScheduleforAffectiveDisordersandSchizophreniawasusedtodetermineaDSM-IVdiagnosis.Adifferentcutoffof6/7forpatientswithstrokeAlsocalleda“brainattack”andhappenswhenbraincellsdiebecauseofinadequatebloodflow.20%ofcasesareahemorrhageinthebraincausedbyaruptureorleakagefromabloodvessel.80%ofcasesarealsoknowasa“schemicstroke”,ortheformationofabloodclotinavesselsupplyingbloodtothebrain.Morewassuggested,whichproducesanimprovedbalancebetweenspecificitySpecificityreferstotheprobabilitythatadiagnostictechniquewillindicateanegativetestresultwhentheconditionisabsent(truenegative).forboththeHADS-A(sensitivitySensitivityreferstotheprobabilitythatadiagnostictechniquewilldetectaparticulardiseaseorconditionwhenitdoesindeedexistinapatient(NationalMultipleSclerosisSociety).Seealso“Specificity.”,0.83;specificitySpecificityreferstotheprobabilitythatadiagnostictechniquewillindicateanegativetestresultwhentheconditionisabsent(truenegative).,0.68)andtheHADS-D(sensitivitySensitivityreferstotheprobabilitythatadiagnostictechniquewilldetectaparticulardiseaseorconditionwhenitdoesindeedexistinapatient(NationalMultipleSclerosisSociety).Seealso“Specificity.”,0.8;specificitySpecificityreferstotheprobabilitythatadiagnostictechniquewillindicateanegativetestresultwhentheconditionisabsent(truenegative).,0.79). Abenetal.(2002)administeredtheHADSto200patientsonemonthfollowingafirsteverischemicstrokeAlsocalleda“brainattack”andhappenswhenbraincellsdiebecauseofinadequatebloodflow.20%ofcasesareahemorrhageinthebraincausedbyaruptureorleakagefromabloodvessel.80%ofcasesarealsoknowasa“schemicstroke”,ortheformationofabloodclotinavesselsupplyingbloodtothebrain.More.Theyfoundthatattheoptimalcutoffof5fortheHADS-AproducedasensitivitySensitivityreferstotheprobabilitythatadiagnostictechniquewilldetectaparticulardiseaseorconditionwhenitdoesindeedexistinapatient(NationalMultipleSclerosisSociety).Seealso“Specificity.”of91.7andaspecificitySpecificityreferstotheprobabilitythatadiagnostictechniquewillindicateanegativetestresultwhentheconditionisabsent(truenegative).of56.1formajordepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.only(areaunderthecurve(AUC)=0.78),andasensitivitySensitivityreferstotheprobabilitythatadiagnostictechniquewilldetectaparticulardiseaseorconditionwhenitdoesindeedexistinapatient(NationalMultipleSclerosisSociety).Seealso“Specificity.”of88.5andspecificitySpecificityreferstotheprobabilitythatadiagnostictechniquewillindicateanegativetestresultwhentheconditionisabsent(truenegative).of71.8fordetectingbothmajorandminordepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.(AUC=0.77).Anoptimalcutoffof8fortheHADS-DproducedasensitivitySensitivityreferstotheprobabilitythatadiagnostictechniquewilldetectaparticulardiseaseorconditionwhenitdoesindeedexistinapatient(NationalMultipleSclerosisSociety).Seealso“Specificity.”of73.1andaspecificitySpecificityreferstotheprobabilitythatadiagnostictechniquewillindicateanegativetestresultwhentheconditionisabsent(truenegative).of81.6fordetectingmajordepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.only(AUC=0.82),andasensitivitySensitivityreferstotheprobabilitythatadiagnostictechniquewilldetectaparticulardiseaseorconditionwhenitdoesindeedexistinapatient(NationalMultipleSclerosisSociety).Seealso“Specificity.”of72.5andspecificitySpecificityreferstotheprobabilitythatadiagnostictechniquewillindicateanegativetestresultwhentheconditionisabsent(truenegative).of78.9fordetectingbothmajorandminordepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.(AUC=0.83).Finally,forthetotalHADS,theoptimalcutoffof11producedasensitivitySensitivityreferstotheprobabilitythatadiagnostictechniquewilldetectaparticulardiseaseorconditionwhenitdoesindeedexistinapatient(NationalMultipleSclerosisSociety).Seealso“Specificity.”of91.7andaspecificitySpecificityreferstotheprobabilitythatadiagnostictechniquewillindicateanegativetestresultwhentheconditionisabsent(truenegative).of65.3fordetectingmajordepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.only(AUC=0.83),andasensitivitySensitivityreferstotheprobabilitythatadiagnostictechniquewilldetectaparticulardiseaseorconditionwhenitdoesindeedexistinapatient(NationalMultipleSclerosisSociety).Seealso“Specificity.”of86.8andspecificitySpecificityreferstotheprobabilitythatadiagnostictechniquewillindicateanegativetestresultwhentheconditionisabsent(truenegative).of69.9fordetectingbothmajorandminordepressionIllnessinvolvingthebody,mood,andthoughts,thataffectsthewayapersoneatsandsleeps,thewayonefeelsaboutoneself,andthewayonethinksaboutthings.Adepressivedisorderisnotthesameasapassingbluemoodorasignofpersonalweaknessoraconditionthatcanbewishedaway.Peoplewithadepressivediseasecannotmerely“pullthemselvestogether”andgetbetter.Withouttreatment,symptomscanlastforweeks,months,oryears.Appropriatetreatment,however,canhelpmostpeoplewithdepression.(AUC=0.84). Johnson,Burvill,Anderson,Jamrozik,Stewart-Wynne,andChakera(1995)administeredtheHADSto93post-strokepatientsandfoundasensitivitySensitivityreferstotheprobabilitythatadiagnostictechniquewilldetectaparticulardiseaseorconditionwhenitdoesindeedexistinapatient(NationalMultipleSclerosisSociety).Seealso“Specificity.”of0.95fortheHADS-Aand0.83fortheHADS-D,withspecificitiesof0.46and0.44,respectively.Theoptimalcutoffscoresusedinthisstudywerenotdisclosed,however,theywereestimatedbyBjellandetal.(2002)tobe5+forHADS-Aand4+forHADS-D. Responsiveness NotyetexaminedinastrokeAlsocalleda“brainattack”andhappenswhenbraincellsdiebecauseofinadequatebloodflow.20%ofcasesareahemorrhageinthebraincausedbyaruptureorleakagefromabloodvessel.80%ofcasesarealsoknowasa“schemicstroke”,ortheformationofabloodclotinavesselsupplyingbloodtothebrain.Morepopulation. 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Snaith,R.P.(2003).Thehospitalanxietyanddepressionscale.HealthandQualityofLifeOutcomes,1(1),29. White,D.,Leach,C.,Sims,R.,Atkinson,M.,&Cottrell,D.(1999).ValidationoftheHospitalAnxietyandDepressionScaleforusewithadolescents.BritishJournalofPsychiatry,175,452-454. Zigmond,A.S.,&Snaith,R.P.(1983).HospitalAnxietyandDepressionScale.ActaPsychiatricaScandinavica,67,361-370. Seethemeasure HowtoobtaintheHADS? TheoriginalisavailableasanappendixinZigmondandSnaith(1983).Acopyofthearticleisavailablebyclickinghere. TheHADSisalsoavailablefromthefollowingwebsite:http://shop.gl-assessment.co.uk/home.php?cat=417. Tableofcontents Theinformationonthiswebsiteisprovidedforinformationalpurposesonlyandisnotasubstituteforprofessionalmedicaladvice.Ifyouhaveorsuspectyouhaveamedicalproblem,promptlycontactyourprofessionalhealthcareprovider. *Theauthorshavenodirectfinancialinterestinanytools,testsorinterventionspresentedinSTROKEENGINE.RelatedAssessmentsAphasicDepressionRatingScale(ADRS)BeckDepressionInventory(BDI,BDI-II)DOCScreenGeneralHealthQuestionnaire-28(GHQ-28)GeriatricDepressionScale(GDS)MontgomeryAsbergDepressionRatingScale(MADRS)PatientHealthQuestionnaire(PHQ-9)StrokeAphasicDepressionQuestionnaire(SADQ) Survey CLOSE Whatdoyouthink?